Shaheen, Hassan Join Moderate Senate Democrats on Letter to Republican Leadership: We Stand Ready to Discuss Improvements to Affordable Care Act and Encourage You Not to Rush to Repeal

**Urging Republicans to consider improvements before causing irreparable damage through outright repeal, Senators highlight their past support for commonsense changes and improvements**

January 05, 2017

(Washington, DC) — Today, U.S. Senators Jeanne Shaheen (D-NH) and Maggie Hassan (D-NH) joined a group of moderate Senate Democrats led by Senator Tim Kaine (D-VA) urging Republican Congressional leadership to discuss meaningful improvements to the Affordable Care Act (ACA) before rushing to fast-track a repeal of the landmark health care law that would strip 30 million Americans of health care insurance. In a letter sent to Majority Leader Mitch McConnell, Health Education Labor & Pensions (HELP) Committee Chairman Lamar Alexander, and Finance Committee Chairman Orrin Hatch, the Senators cited their prior support of bipartisan reforms to the ACA and their willingness to work together in order to avoid an outright repeal of the law that would increase health care costs, hurt middle class families, and cause irreparable damage to the American health care system.

“We know there is more to do to improve the health care system in our country, and agree that there are serious challenges that must be addressed,” the Senators wrote. “We have supported commonsense changes and improvements to the Affordable Care Act to ensure affordability and access for more Americans, and have been ready and willing to work with anyone to improve the existing law for our constituents.”

“We remain committed to improving the ACA and we urge you to work with us now—to increase affordability for families, protect communities, help small businesses, and continue important protections for the most vulnerable,” the Senators continued. “But by pushing an immediate repeal through a partisan reconciliation process, we won’t have the opportunity to work together and build on common ground. By moving forward with no plan in place for the future of our health care system, those who support repeal assume the responsibility of mitigating the unnecessary and avoidable chaos this will create.

We write to express our concerns with the plans to use a fast-track budget process to repeal the Affordable Care Act in the coming weeks. Repealing this law will have immediate negative impacts on the people we represent and the economy as a whole. While we believe improvements are needed to ensure high-quality health care is affordable for all Americans, we cannot afford to make a mistake that will lead to the loss of health care for our constituents.

We know there is more to do to improve the health care system in our country and agree that there are serious challenges that must be addressed. We have supported commonsense changes and improvements to the Affordable Care Act to ensure affordability and access for more Americans and have been ready and willing to work with anyone to improve the existing law for our constituents. The American people deserve a constructive bipartisan conversation about improvements we know need to be made to our health care system, and that will require time for the two sides to work together. Any proposed changes must protect the parts of law that have helped our constituents access critically needed health care.

Unfortunately, outright repeal means that an estimated 30 million people would lose their health coverage, doubling the rate of uninsured, endangering our constituents’ access to needed health care services, and exposing them and their families to new financial risks if they become ill. The vast majority—eighty-two percent—of those who would become uninsured are in working families.

The negative impacts would be felt across the health care system by consumers, states, and health care providers even if there is a delay and repeal does not fully take effect for several years. States would very likely see their individual insurance markets begin to unravel quickly due to uncertainty that would drive insurers to either leave the market or raise premiums significantly. The Urban Institute estimates that 4.3 million people are at risk for losing insurance right away, and this cycle would only accelerate once the marketplace subsidies are repealed, making coverage much less affordable for people with modest incomes. According to the American Academy of Actuaries, “Repealing major provisions of the ACA would raise immediate concerns that individual market enrollment would decline, causing the risk pools to deteriorate and premiums to become less affordable. Even if the effective date of a repeal is delayed, the threat of a deterioration of the risk pool could lead additional insurers to reconsider their participation in the individual market.”

As individuals lose health coverage, we would also expect to see a return to high uncompensated care costs, which would burden state and local governments and health care providers. Constituents in rural and underserved urban communities would be particularly hard hit given the economic importance of hospitals, federally qualified health centers, and clinics in many small towns. People who have pre-existing conditions, such as cancer, diabetes, and heart disease, could face new challenges in obtaining coverage and affording their care, as repeal would endanger the popular protections now provided to them in the insurance market. And repeal would hamper our ability to combat the opioid epidemic by taking away access to substance abuse treatment from millions of Americans.

We are also concerned about the impact of repeal on Medicare beneficiaries. The ACA included provisions to improve Medicare benefits by providing free coverage for some preventive benefits, such as screenings for breast and colorectal cancer, cardiovascular disease, and diabetes, and closing the coverage gap in the Part D drug benefit by 2020.

In addition to taking away coverage for seniors and families, undermining the health care system through outright repeal would hurt our economy. Health care makes up one sixth of the nation's GDP; a hasty repeal vote with no clear plan for replacing the law will inject tremendous uncertainty into the American economy. Creating that degree of uncertainty is bad for both the health care system and the economy and is likely to have negative consequences. Congress should be trying to reduce economic uncertainty, not multiply it.

We remain committed to improving the ACA, and we urge you to work with us now—to increase affordability for families, protect communities, help small businesses, and continue important protections for the most vulnerable. But by pushing an immediate repeal through a partisan reconciliation process, we won’t have the opportunity to work together and build on common ground. By moving forward with no plan in place for the future of our health care system, those who support repeal assume the responsibility of mitigating the unnecessary and avoidable chaos this will create.